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At least 757 records · Page 42Linked to original sources
PubMed2003

High body mass index, asthma and allergy in Swedish schoolchildren participating in the International Study of Asthma and Allergies in Childhood: Phase II.

AIM: To assess the relationship between high body mass index (BMI) and asthma and atopic manifestations in 12-y-old children. METHODS: The relationship between high BMI and asthma symptoms was studied in 457 sixth-grade children, with (n = 161) and without (n = 296) current wheeze. High BMI was defined as > or = 75th percentile of gender-specific BMI reference values for Swedish children at 12 y of age; overweight as a subgroup of high BMI was defined as > or = 95th percentile. Children with a BMI < 75th percentile served as controls. Questionnaires were used to assess asthmatic and allergic symptoms, and bronchial hyperresponsiveness was assessed by hypertonic saline provocation tests. RESULTS: Current wheeze was associated with high BMI after adjustment for confounding factors (adjusted OR 1.7, 95% CI 1.0-2.5) and overweight had an even more pronounced effect (adjusted OR 1.9, 95% CI 1.0-3.6). In addition, asthma severity was associated with high BMI, as evaluated by the number of wheezing episodes during the previous 12 mo among the wheezing children (adjusted OR 2.0, 95% CI 1.0-4.0). There was also an association between high BMI and the presence of eczema in wheezing children (adjusted OR 2.2, 95% CI 1.0-4.6). However, high BMI was not significantly associated with hay fever, positive skin prick tests or bronchial hyperresponsiveness. CONCLUSION: The study confirms and extends a previously observed relationship between BMI and the presence of wheezing and asthma.

Adolescent↗
PubMed1992

[Clinical epidemiology of bronchial asthma in children report. No. III. Comparison of prevalence of asthma with 1982 and 1990 and environmental factors].

UNLABELLED: In 1982, our group carried out a survey by the questionnaires and on the site medical check-ups to observe and occurrence of asthma and other allergic symptoms in elementary and junior high school children in Izu Ohshima island. Same procedure was repeated in 1990 for 1145 children of the same age group to see any data fluctuation. The occurrence of allergic symptoms with relation to living conditions was also researched. RESULT: 114 students (11.0%) had either suffered from asthma in the past, or were still currently exhibiting symptoms, this marked a 7.5% rise (108 students) over the 1982 research data. However, patients in need of current treatment numbered 48 (4.5%), which was similar to the 1982 data of 82 (4.3%). For other allergic symptoms, rhinitis showed a marked increase over the 1982 data. The relation between living conditions and asthma was analyzed by Multiple Factor Analysis Quantification Theory. RESULT: 1) Family history of allergy, 2) Selection of food products upon starting solids during infancy, 3) Infection of lower bronchus during infancy all seemed to have had much influence on the occurrence of asthma.

Adolescent↗
PubMed2004

[Rice pollen asthma and pollinosis in childhood: seasonal asthma and allergic rhinoconjunctivitis during the period of rice pollen emission in the surrouding area of rice field].

Although in 1969, rice pollen was first reported as a cause of asthma, rice pollen allergy has not been studied after the first report and thus the allergic significance of rice pollen is not well recognized at present. We investigated the sensitization to various allergens and the residential areas in children with the symptoms of asthma or rhinoconjunctivitis during the first decade of August, and measured rice pollen-specific IgE antibodies. Eighty-eight children (57 boys and 31 girls, mean age 8.5+/-2.9 years) with bronchial asthma or allergic rhinitis/conjunctivitis were included in this study and divided into two groups: children with (n=21) or without (n=67) symptoms during this period. The positivity rate to orchard grass pollen and the rate of residence in the surrounding area of rice field were high (81%, P=0.008 and 86%, P<0.001, respectively) in children with allergic symptoms, as compared to the values (48% and 27%, respectively) in children without symptoms. As the rice pollen season in Nagano occurs in the first decade of August, we measured rice pollen-specific IgE antibodies in 8 patients with symptoms during this period; all of these patients showed positive IgE antibodies to rice pollen. The RAST-inhibition assay using orchard grass and rice pollen indicated cross-allergenecity between these two pollen and also the existence of rice pollen-specific allergens. These results suggest that rice pollen induces seasonal asthma and allergic rhinoconjunctivitis during the first decade of August, which is the rice pollen season, in the surrounding area of rice fields.

Adolescent↗
PubMed2004

Processes of care for individuals with work related asthma: treatment characteristics and impact of asthma on work.

The prevalence of asthma among working adults continues to rise each year. The California Department of Health Services conducts surveillance of work related asthma (WRA) to classify each work related exposure using Doctor's First Reports of Occupational Illness and Injury (DFRs). Using a cross-sectional, descriptive, comparative design, additional interviews were conducted and medical records were reviewed to explore workers' and providers' perceptions of follow up care. Two cohorts were compared: workers with WRA who belonged to a large, single HMO (n = 79) and workers with WRA who underwent follow up outside this HMO (n = 76). The interview asked about providers seen, tests ordered, and the impact of asthma on work. The HMO clients were significantly more likely than the non-HMO clients to see occupational medicine specialists (p = .004) and have pulmonary function testing (p = .049) during initial treatment. Twenty-four percent of clients currently working reported missed workdays caused by asthma in the past 6 months. The findings indicate management of WRA varies by health care system in California.

Absenteeism↗
PubMed2004

[The current managements and controversies of the clinical practice for patients with asthma. A questionnaire survey of asthma management for doctors professing internal medicine in Saitama prefecture].

A questionnaire survey of the current medical therapy in patients with mild persistent (step 2) asthma was conducted of doctors professing internal medicine in Saitama prefecture. Responses were obtained from 933 of those surveyed (response rate: 53%). Medications frequently prescribed for asthma control were theophylline (77%), inhaled corticosteroids (ICSs: 75%), and leukotriene modifiers (64%). Usage of theophylline in exacerbation reached 87% and was given priority over inhaled beta2-agonist, suggesting too much usage of theophylline among respondents. ICSs were used in 75% of respondents. Doctors specializing in respiratory or allergic medicine used ICSs more frequently than the others. They started ICSs at large doses initially (48%), followed by small doses, and they showed a trend of continuing ICSs after the asthma was under control (75%). Eighty-three percent of respondents used leukotriene modifiers, which were evaluated as easy to administer orally, having a synergistic effect with ICSs, and having fewer side effects compared with other asthma medications.

Administration, Inhalation↗
PubMed2004

[Effectiveness and safety of fluticasone propionate in therapy of children suffering from asthma. Part I. Mechanisms of actions and clinical effectiveness of treatment in children with asthma].

The introduction of inhaled corticosteroids (ICS) has been a milestone in asthma therapy. According to current guidelines ICS are the first line drug in chronic anti-inflammatory therapy. The purpose of first part of this publication is to present updated knowledge on mechanisms of anti-inflammatory action as well as some pharmacokinetics and pharmacodynamics data about commonly used ICS, especially fluticasone propionate (FP) and two others: budesonide (BUD), beclomethasone dipropionate (BDP). Some differences between mentioned drugs have been found concerning systemic activity and safety of therapy. Fluticasone propionate is twice as active as the BUD and BDP. First results of therapy are seen 1-2 week after administration. Fluticasone propionate, more lipophilic than other steroids, has also high glucocorticoid receptor affinity and specificity, high topical anti-inflammatory activity and low systemic bioavailability. Systemic availability of FP depends on absorption from respiratory system. Oral bioavailability can be neglected because of almost total inactivation in liver during first pass. Fluticasone propionate has some features of dissociated steroids which means predominance of transrepression over transactivation--beneficial from safety point of view. Clinical efficacy of FP in chronic asthma therapy in children was confirmed in many studies. It significantly reduces the symptoms and exacerbations of asthma. There is a close correlation between FP use and lung function tests. The therapy with FP decreases bronchial hyperreactivity and the use of systemic steroids and rescue medication. The beneficial action of fluticasone propionate in asthma is due its anti-inflammatory properties within the airways (decreasing levels of direct and indirect markers of airways inflammations are observed).

Administration, Inhalation↗
PubMed2005

Responsiveness, longitudinal- and cross-sectional construct validity of the Pediatric Asthma Quality of Life Questionnaire (PAQLQ) in Dutch children with asthma.

OBJECTIVE: Health-related quality of life is an important measure in evaluations of the management of childhood asthma. In this study, we assessed psychometric properties, responsiveness, and longitudinal and cross-sectional construct validity of the Dutch version of the 23-item Pediatric Asthma Quality of Life Questionnaire (PAQLQ). METHODS: The study group consisted of 238 6-18-year olds with asthma, with complete respiratory symptom diaries in the course of one winter season; each child had one (or more) PAQLQ measurement(s) concerning one (or more) week(s) with relatively many symptoms (n = 238). Each child also had one PAQLQ measurement concerning another week with relatively few symptoms (n = 238). The PAQLQ scores of the 238 children for a week with few symptoms (the symptom diary scores remained below a predefined level everyday) were compared with their PAQLQ scores for another week with many symptoms (on day 1 of that week, symptom diary scores had been above the predefined level). Additionally, in a subgroup of the study group that had experienced two or more 'weeks with many symptoms' (n = 101), we compared the PAQLQ-scores for two different weeks with many symptoms of these children. RESULTS: Only the domain Emotions showed a ceiling effect (>25% had the maximum score). All Cronbach's alpha's of the PAQLQ total score and domains were >0.70, except for Activities (alpha = 0.54). Mean PAQLQ-scores were significantly different (p < 0.01; n = 238) between one week with few symptoms and another week with many symptoms. Contrary, in the subgroup of children with PAQLQ-measurements regarding more than one week with many symptoms (n = 101), mean PAQLQ-scores did not differ significantly (p > or = 0.05) between 1 week with many symptoms and another week with many symptoms. These results indicate responsiveness. (Changes in) lower respiratory tract symptoms, indicative of asthma severity, correlated better with (changes in) PAQLQ scores than (changes in) upper respiratory tract symptoms, which supports the longitudinal and cross-sectional construct validity. CONCLUSION: The assessed properties of the PAQLQ linguistic validation into Dutch were similar to those originally established for the PAQLQ in Canada. This study showed that the Dutch PAQLQ has adequate psychometric properties, excellent responsiveness, and that the longitudinal and cross-sectional construct validity is supported.

Adolescent↗
PubMed2005

Advancing asthma management: asthma care education and improved outcomes.

According to the American Lung Association, the National Center for Health Statistics, and the Centers for Disease Control and Prevention, an estimated 15 million to 20 million Americans have asthma. Those numbers include approximately 5 million to 6 million children younger than 18 years of age. Asthma is the most common chronic illness among children, and it is one of the main causes of emergency room visits, inpatient admissions, and school absenteeism, especially among those younger than 15 years of age. In Minnesota, approximately 8% of middle school students have asthma, and another 18% may have the disease. The highest rates are found in the Twin Cities metro area. This article describes an educational program to help physicians make more accurate diagnoses and improve asthma care by providing evidence-based treatment.

Adolescent↗
PubMed2006

Beating asthma: a community-based asthma education initiative.

Beating Asthma is a community-based educational intervention designed to empower people with asthma by providing them with information about their pulmonary disease. The project consists of a series of three lectures delivered in a single 2-hour evening program by a pulmonologist, a health educator, and a licensed clinical psychologist. Surveys were distributed to participants before and after the program to assess general knowledge of asthma, the disease's pathophysiology, and asthma-management skills. Seventy-eight (77%) of the 101 families participating in the event completed both questionnaires. Regression model analysis of survey results showed that participants with the lowest scores before intervention achieved the greatest gains after intervention (P<.001). Analysis of the three topic areas revealed that only the subscore for disease management differed significantly from zero (P<.001). The authors assess the quality and usefulness of the survey instrument and the lecture content for future use.

Asthma↗
PubMedDate not supplied

[Pharmaco-prevention of bronchial asthma using membrane stabilizers and asthma mortality].

The increase in the incidence of bronchial asthma is not necessarily accompanied by an increase in death rates; furthermore, the knowledge of the intimate physiopathogenic mechanisms of the disease, the appearance of new drugs with pharmaceutical forms that make them more available for patients, should improve the effectiveness of the treatment. In spite of that, the asthma death rate curves increase as drug sales increase. Some authors think this is caused by factors depending on the patient, the health system and, nowadays, the inappropriate use of the available drugs is thought to be one of the reasons for the increase in asthma death rates, and the use of drugs that only supply to the patient an adequate bronchodilation may mask the underlying inflammatory process, what unavoidably leads to irreversible deteriorations in the airways, with smooth muscle hypertrophy and thickening of the basal membrane. It is logical to think that children's bronchial asthma is the first stage of a progressive illness, in which the allergic factor is really meaningful, and that is why a suitable prophylaxis with early use of drugs with antiinflammatory activity may prevent the development of irreversible deteriorations of bronchial and lung parenchyma. Oral or inhalatant corticoids, disodium cromoglycate, ketotifen and nedocromil are the drugs with well-known antiinflammatory activity, though they have a different site of action, as corticoids act directly on inflammatory cells, inhibiting the activity of macrophages and particularly of eosinophils, while cromoglycate, nedocromil and ketotifen inhibit mediators release, thus stabilizing mastocyte membrane.

Argentina↗
PubMed1989

Pathology of bronchial asthma and animal models of asthma.

We reviewed studies on pathology of status asthmaticus, asymptomatic asthma, and of animal models developed to study the pathogenesis of asthma. In status asthmaticus airway occlusion by mucous plugs, desquamed epithelium, goblet cell hyperplasia, submucosal glands hypertrophy, increased smooth muscle, basal membrane thickening, inflammatory infiltration of the bronchial mucosa are observed, together with focal areas of alveolar wall destruction in lung parenchyma. At variance with active asthma, in which almost invariably inflammatory cells infiltrate the mucosa, only scarce airway inflammation is reported in asthmatics between attacks. The majority of the animal models developed so far have been addressed to investigate the mechanism of the transient hyperreactivity that is associated with exacerbations of asthma, while little information is available on the structure-function relationship on long-lasting hyperresponsiveness.

Airway Obstruction↗
PubMed1989

Prevalence of asthma and asthma symptoms in a general population sample of north Italy.

The prevalence rates of asthma and asthma symptoms were investigated in a general population sample (n = 3,289) living in a rural area of northern Italy. The subjects received a standard questionnaire and performed lung function tests with automated equipment. The overall prevalence rate of reported diagnosis of asthma was 5%. In young nonsmokers of both sexes the prevalence rates of reported diagnoses were higher than those of symptoms whilst the reverse occurred in older age groups. The prevalence rates decreased from childhood to young adults and increased again in older age groups. In smokers, reported diagnoses and symptoms increased with age and the prevalence rates of symptoms were always higher than those of diagnoses. Smokers with symptoms and reported diagnoses had lower lung function parameters than those with only symptoms. The distribution of asthma symptoms in our population indicates the importance of cigarette smoke and other environmental factors in the expression of the disease.

Adolescent↗
PubMed1994

Guidelines for the management of asthma in adults in South Africa. Part II. Acute asthma. Working Group of the South African Pulmonology Society.

The morbidity and mortality caused by asthma can be attributed to three factors: underassessment of severity, failure on the part of both patients and their medical attendants to initiate treatment promptly, and undertreatment of exacerbations. Moreover, most exacerbations can be prevented by use of appropriate long-term treatment (S Afr Med J 1992; 81: 319-322). The present guidelines are for the care of acute asthma ('asthma attacks') and are intended to encourage a uniform approach to the management of exacerbations, whether of rapid or gradual onset, mild or severe. They have been developed on the basis of the best available evidence on the efficacy and safety of asthma drugs, and efforts have been made to ensure that recommendations are cost-effective and affordable, and may with little modification be applied in all locations: the home (as initial self-management), the clinic with modest facilities, doctors' surgeries, emergency departments and hospitals. The guidelines stress (i) assessment of severity; (ii) recognition of risk; and (iii) stepwise treatment based upon these assessments. Primary therapies are the repeated use of high doses of beta 2-agonists and early introduction of corticosteroids. Specific goals of treatment are to: (i) relieve airway obstruction; (ii) relieve hypoxaemia; (iii) restore lung function to normal as rapidly as possible by reducing airway irritability; (iv) provide a suitable plan to avoid future relapse; and (v) provide a written plan of action to be followed early in future attacks. Simplified management schemes for different locations are provided as addenda for ease of reference.

Acute Disease↗
PubMed1993

Characteristics of airway responses in patients with bronchial asthma. Evaluation of asthma classification systems based on clinical symptoms and clinical findings.

Asthma was classified into three types according to clinical symptoms (clinical diagnosis, C.D.): Ia. simple bronchoconstriction type (further divided into two subtypes, type Ia-1 with 0-49 ml/day of expectoration and type 1a-2 with 50-99 ml/day); Ib. bronchoconstriction + hypersecretion type, and II. bronchiolar obstruction type. Asthma was also classified by a score related to clinical findings and examinations (score diagnosis, S.D.). The clinical features of each type of asthma according to the two classifications methods were compared. Type 1a-2 and 1b patients (C.D.) were characterized by mucus hypersecretion (more than 50 ml/day) and eosinophilia in the bronchoalveolar lavage (BAL) fluid. The characteristic findings for type II asthmatics (C.D.) were a lower %V25 value (less than 10%) and an increased proportion of neutrophils (more than 20%) in the BAL fluid. All of the patients classified as types 1a-1, Ib, and II by clinical diagnosis were evaluated as having the same types of asthma by score diagnosis. Patients with type Ia-2 evaluated by clinical diagnosis were classified as type Ib by score diagnosis, since these two types had similar pathophysiological features represented by the increased proportion of eosinophils in the BAL fluid.

Adult↗
PubMed1995

The role of the pharmacist in improving asthma care. National Asthma Education and Prevention Program.

Our current understanding of the pathophysiology of asthma and the availability of potent, effective therapies mean that asthma can be well controlled. However, to achieve this goal, optimal therapy must be prescribed and the patient must be taught how and when to use it. Pharmacists, as part of the health care team, help improve the pharmacologic management of asthma by teaching patients about their medications, how to use them, and the importance of using them as prescribed. Alerting physicians to suspected problems, such as underusing anti-inflammatory therapy or overusing inhaled bronchodilators, will provide an opportunity for the physician to consider changes in a patient's management plan when appropriate. Acting in these educational and information-sharing roles, pharmacists contribute to improving the control of asthma and enabling patients to live full, active, and productive lives.

Administration, Inhalation↗
PubMed1996

[Severe asthma was found to be an asthma-like condition. Consider reduced doses of cortisone].

A middle-aged man with variable breathing problems and frequent acute attacks, diagnosed as severe bronchial asthma, was given high-dose oral corticosteroid treatment. Owing to the somewhat atypical history, and normal lung function test results despite severe concomitant asthma-like symptoms, the diagnosis was reconsidered. As a new diagnostic work-up showed the presence of a disease of slight to moderate severity, it was decided to taper off the corticosteroid treatment. Within one year the daily dose of prednisolone was decreased from 40 to 7.5 mg without deterioration of the airway symptoms or impairment of lung function. Re-evaluation also showed the principal diagnosis not to be bronchial asthma but an asthma-like condition (functional breathing disorder combined with sensory hyperresponsiveness), and alternative not previously considered and a condition in which steroids are without apparent effect. This case illustrates the importance of a critical re-view of the diagnosis before high-dose corticosteroid treatment with its inevitable side effects is instituted.

Acute Disease↗
PubMed1996

[Relation between the sialic acid/fucose ratio in airway secretions and the degree of airway remodeling in bronchial asthma--reversibility of airflow limitation by beta-agonists and airway remodeling in bronchial asthma].

Airway remodeling caused by inflammation is believed to affect both airway hyperresponsiveness and the reversibility of airflow limitation. Airway remodeling entails changes in the bronchial secretion system. Mucin, one of the glycoprotein components of airway secretions, is a major product of submucosal glands and goblet cells. Airway remodeling causes both qualitative and quantitative changes in much production. We evaluated the relationship of airway remodeling, estimated by the change in glycoprotein in sputum, to airway hyperresponsiveness and to reversibility in patients with bronchial asthma. The %FEV1 after inhalation of a beta agonist was less in patients with severe asthma than in those with mild asthma. The sialic acid/fucose ratio in sputum correlated significantly with the slope of the dose-response curve during inhalation challenge, and with the %FEV1 after beta-agonist inhalation. These results suggest that the sialic acid/ fucose ratio in airway secretions reflects the degree of the airway remodeling in bronchial asthma.

Administration, Inhalation↗
PubMed1997

Application of asthma action plans to childhood asthma: a national survey.

AIM: To determine the frequency of asthma action plan use by doctors in the management of childhood asthma in New Zealand, and their recommendations about the application of an increased dose of inhaled steroids in those plans. METHODS: A postal survey was sent to all 236 paediatricians and paediatric registrars and to a random sample of 500 general practitioners (GPs) in New Zealand. Questions related to asthma action plan use, the inclusion of an increased dose of inhaled steroid in those plans and details of the way the inhaled steroid dose is adjusted. RESULTS: Valid responses were received from 168 (71%) paediatricians and paediatric registrars and 340 (68%) GPs. The majority (92.6%) of GPs and paediatricians and paediatric registrars used action plans and 83.6% included a step involving an increased dose of inhaled steroids. Compared with paediatricians and paediatric registrars, GPs gave action plans to a smaller proportion of asthmatic children in their care and included an increased dose of inhaled steroid more often (GPs = 94.5%, paediatricians and paediatric registrars = 57%). CONCLUSION: In New Zealand the use of asthma action plans is inconsistent with the recommendations contained in published consensus documents in that not all asthmatic children are advised about an action plan. Specific issues relating to this and to the use of an increased dose of inhaled steroids in action plans require clarification and further research.

Administration, Inhalation↗